Arterialization of the Venous System of the Hand

Abstract

The treatment of hand ischemia can be very challenging. In cases in which there are no reconstructible arterial lesions, treatment options are limited. Arterialization of the venous system of the hand is a straightforward surgical procedure that provides arterial blood to the distal soft tissues of an ischemic hand. The author conducted a retrospective review of the history, indications, technique, and results of this technique as applied to the treatment of five hands in three patients. For each of these patients, the treatment included an anastomosis from the distal radial or ulnar artery to a dorsal hand vein. Blood flow was directed distally by ligating venous side branches. Valvulotomies were performed as needed to the base of the digits on the dorsum of the hand. This approach resulted in excellent pain relief in all treated hands and healing of digital wounds. This relatively straightforward salvage procedure provides arterialized blood to ischemic digits, resulting in wound healing and significant reduction in pain.